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A 63 y old male with long standing history of dyspnea, and recurrent cough and expectoration was initially thought to be suffering from recurrent lower respiratory tract infection (LRTI) and fibrosing alveolitis. The latest plain chest radiograph showed dilated trachea and bronchi in addition to bilateral diffuse interstitial lung disease. The chest CT scan confirmed the abnormally tracheobronchomegaly which was consistent with the diagnosis of the rare Mounier-Kuhn syndrome of an apparently a sporadic form. Such diagnosis should be considered in the differential diagnosis of settings with radiological findings suggestive of LRTI. The case also emphasizes the importance of the size of air passages on the plain chest radiograph.

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